Presentation
Intermittent pain around the ankle joint, worse on the left. Pain is worsened after walking.
Patient Data
Both tarsal navicular bones are small, abnormal in shape, fragmented and partly sclerotic. There is mild soft tissue swelling around the ankle joint. These findings are compatible with Köhler disease.
Case Discussion
Köhler disease is avascular necrosis of the navicular bone, commoner in boys between the ages of 4 and 6 years. It is typically a self-limiting condition.
This condition is believed to be due to a mechanical cause from delayed ossification. The navicular is the last tarsal bone to ossify which may get compressed between the already ossified talus and cuneiforms as the child grows. Hence, the navicular blood supply is susceptible to compressive ischemia leading to avascular necrosis. The prognosis is excellent due to the radial pattern of blood supply to the navicular bone 1.
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